CMS Manual System - Centers for Medicare & Medicaid Services

In the hospital inpatient setting, payment for Aranesp is included in the DRG.
In a skilled nursing facility (SNF), payment for Aranesp covered under the Part B
EPO benefit is not included in the prospective payment rate for the resident’s
Medicare-covered SNF stay.
In a hospice, payment is included in the hospice per diem rate.
For a service furnished by a physician or incident to a physician’s service, payment is
made to the physician by the carrier in accordance with the rules for ‘incident to”
services. When Aranesp is administered in the renal facility, the service is not an
“incident to” service and not under the “incident to” provision.
60.7.3.2 - Payment for Darbepoetin Alfa (Aranesp) in the Hospital
Outpatient Department
(Rev 118, 03-05-04)
For patients with chronic renal failure who are not yet on a regular course of dialysis,
Aranesp administered in a hospital outpatient department is paid under the OPPS.
Hospitals use bill type 13X and report charges under revenue code 0636, with HCPCS
code Q0137 and without value codes 48, 49, 68 or condition codes 70-76.
60.7.4 – Darbepoetin Alfa (Aranesp) Furnished to Home Patients
(Rev 118, 03-05-04)
B3-4270.1
Medicare covers Aranesp for dialysis patients who use Aranesp in the home, when
requirements for a patient care plan and patient selection as described in the Medicare
Benefit Policy Manual, Chapter 11, are met.
When Aranesp is prescribed for a home patient, it may be either administered in a
facility, e.g., the one shown on the Form CMS-382 (ESRD Beneficiary Method Selection
Form) or furnished by a facility or Method II supplier for self-administration to a home
patient determined to be competent to administer this drug. For Aranesp furnished for
self-administration to Method I and Method II home patients determined to be competent,
the renal facility bills its FI and the Method II supplier bills its DMERC. No additional
payment is made for training a prospective self-administering patient or retraining an
existing home patient to self-administer Aranesp.
Method II home patients who self-administer may obtain Aranesp only from either their
Method II supplier or a Medicare-certified ESRD facility.
In this case, the DMERC makes payment at the same rate that applies to facilities.
Program payment may not be made for Aranesp furnished by a physician to a patient for
self-administration.